Addressing the nation’s mental health crisis relies on a strong Medicaid program.

The United States is enduring a significant mental health crisis, with nearly one in three adults experiencing anxiety and depression symptoms in 2023¹. The problem, exacerbated by the pandemic, is particularly acute among children and youth². The American Academy of Pediatrics and other health groups have declared a national emergency in child and adolescent mental health³. Suicide is the second leading cause of death among youth ages 10 to 24⁴. Two in five adolescents ages 12 to 17 had persistent feelings of sadness or hopelessness⁵ and 4.5 million experienced a major depressive episode⁶. Disparities are a part of these grave statistics among both youth and adult populations. LGBTQ+ youth experience more signs of poor mental health than their peers⁷. Multiracial adults ages 18 or older are most likely to have serious thoughts of suicide⁸. Medicaid plays a pivotal role by providing access to care for many people who would otherwise not be able to afford it, making it an indispensable part of the nation’s response to the mental health crisis.

Medicaid has played a major role in increased access to and engagement in mental health services. 

Individuals, families, and friends are overcoming the stigma of mental illness and recognizing the importance of high-quality health services. The share of youth⁹ and adults receiving mental health treatment has increased in recent years¹⁰. For working parents and other adults, Medicaid expansion made this increased access possible,¹¹ along with changes to private insurance and Affordable Care Act (ACA) marketplace coverage¹². Forty states and the District of Columbia have expanded Medicaid under the ACA, putting mental health care within reach of more working parents and other adults who gained coverage¹³. One study found that “Medicaid expansion was associated with improved access to care and medication among persons with depression, even in areas with relative shortages of mental health professionals.”¹⁴

Medicaid is the single largest payer of mental health services in the United States.

In 2020, nearly 40% of the non-elderly adult Medicaid population had a mental health or substance use disorder; most of that population qualifies for Medicaid because of their income status¹⁵. Medicaid expansion has been an essential piece of the puzzle in addressing the mental health crisis. State expansions have been shown to lead to an increase in annual mental health outpatient visits¹⁶. Health coverage is also associated with overall peace of mind and lower financial stress, especially among adults with chronic conditions¹⁷.

Medicaid helps pregnant women and new mothers access mental health care that helps them bond with their newborns.

One in five pregnant women and new mothers experience mental health conditions, including postpartum depression or anxiety, which impact the wellbeing of the whole family¹⁸. Untreated mental health challenges are among the leading causes of the U.S. maternal mortality crisis. Many such deaths are preventable. Maternal mental health conditions affect 800,000 families each year nationally, with the majority of impacted individuals remaining untreated¹⁹. That increases the risk of long-term negative impacts on mothers, babies, and families, and also comes with significant costs when treatment and hospitalization are eventually required²⁰. Untreated mental health conditions are also associated with delays in cognitive²¹ and social-emotional development for young children²². All but two states have extended postpartum coverage to pregnant women covered by Medicaid to twelve months, with many also leading efforts across public and private insurance to ensure pregnant and postpartum women receive the mental health care they need in a timely manner²³.

Medicaid’s pediatric benefit offers a lifeline for children and youth with mental health needs.

Access to mental health care can make a difference in health and social development for young people and is a critical component of addressing the child and adolescent mental health crisis. Medicaid (alongside its much smaller sister program, the Children’s Health Insurance Program) covers about half of the nation’s children. Medicaid’s pediatric benefit, known as Early and Periodic Screening, Diagnostic, and Treatment or EPSDT, requires child and adolescent providers to screen, diagnose, and treat behavioral health conditions and states to cover this essential care²⁴. States have leveraged Medicaid to boost school-based mental health services to help address the youth mental health crisis²⁵. More states are also embracing age-appropriate preventive mental health interventions that support strong early childhood development²⁶.

Medicaid provides important coverage for people with both mental health and substance use disorders.

While it is crucial to build equitable access to mental health and substance use services as separate entities, it is equally important to recognize that physical, mental, and substance use concerns often co-exist. According to the 2023 National Survey on Drug Use and Health, more than 1 in 3 U.S. adults who have a mental health condition also have a substance use disorder²⁷. Adolescents with substance use disorders have high rates of co-occurring mental issues, including mood and anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder. Medicaid covers essential prevention, intervention, and treatment services including essential medications for children and families with mental health and substance use disorder needs.

Medicaid supports community-based mental health providers.

Medicaid plays a key role in supporting community-based mental health providers including through the Certified Community Behavioral Health Clinic (CCBHC) demonstration program²⁸. Under the CCBHC demonstration program, states receive enhanced federal Medicaid support in exchange for meeting certain requirements²⁹, such as providing services to all individuals regardless of ability to pay; offering timely access to mental health and substance use services; and showing demonstrated impact in decreasing hospitalization, homelessness, and time in jails³⁰. Outside of CCBHCs, parity requirements can help improve integrated care for Medicaid and other insurers, emphasizing the need for a comprehensive approach to mental health that meets individuals where they are.

Medicaid serves as a lifeline to millions of Americans with mental health needs. It supports the mental health and wellbeing of low-income children, youth, pregnant women, new mothers, and other adults amid a documented mental health crisis. More must be done to support the mental health workforce and address the mental health needs of youth and individuals across the country and a strong Medicaid program is fundamental to such efforts.

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Endnotes

1. N. Panchal, H. Saunders, R. Rudowitz, & C. Cox, “The Implications of COVID-29 for Mental Health and Substance Use” (Washington: KFF, March 20, 2023), available here. ↩︎
2. Office of the Surgeon General, “Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory” (Washington: Office of the Surgeon General, 2021), available here. ↩︎
3. American Academy of Pediatrics, AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health, Statement (October 19, 2021), available here. ↩︎
4. L. Hua, J. Lee, M. Rahmandar, & E. Sigel, “Suicide and Suicide Risk in Adolescents,” Pediatrics, 153, no. 1 (2024): e2023064800. ↩︎
5. R. Chatterjee, “We’re not ‘out of the woods’ in the youth mental health crisis, a CDC researcher says” (Washington: NPR, August 7, 2024), available here. ↩︎
6. Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA Releases Annual National Survey on Drug Use and Health, Press Release (July 30, 2024), available here. ↩︎
7. The Trevor Project, “2024  U.S. National Survey on the Mental Health of LGBTQ+ Young People” (The Trevor Project, 2024), available here. ↩︎
8. K. Angelone, “U.S. National Trends and Disparities in Suicidal Ideation, Suicide Attempts, and Health Care Use” (Washington: Pew Charitable Trusts, September 30, 2024), available here. ↩︎
9. Substance Abuse and Mental Health Services Administration (SAMHSA), “Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health,”HHS Publication No. PEP24-07-021, NSDUH Series H-59, (Rockville, MD: SAMHSA, Center for Behavioral Health Statistics and Quality, 2024), available here. ↩︎
10. N. Panchal and J. Lo, “Exploring the Rise in Mental Health Care Use by Demographics and Insurance Status” (Washington: KFF, August 1, 2024), available here. ↩︎
11. K. Griffith and J. Bor, “Changes in Health Care Access, Behaviors, and Self-reported Health Among Low-Income US Adults Through the Fourth Year of the Affordable Care Act,” Medical Care, 58, no. 6 (June 2020): 574-578; C. Fry and B. Sommers, “Effect of Medicaid Expansion on Health Insurance Coverage and Access to Care Among Adults with Depression,” Psychiatric Services, 69, no. 11 (August 2018). ↩︎
12. P. Novak, A. Anderson, & J. Chen, “Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act,” Administration and Policy in Mental Health and Mental Health Services Research, 45, (2018): 924-932. ↩︎
13. KFF, “Status of State Medicaid Expansion Decisions” (Washington: KFF, February 12, 2025), available here. ↩︎
14. C. Fry and B. Sommers, op. cit. ↩︎
15. M. Guth, H. Saunders, B. Corallo, & S. Moreno, “Medicaid Coverage of Behavioral Health Services in 2022: Findings from a Survey of State Medicaid Programs” (Washington: KFF, March 17, 2023), available here. ↩︎
16. J. Breslau, B. Han, J. Lai, & H. Yu, “Impact of the Affordable Care Act Medicaid Expansion on Utilization of Mental Health Care,” Medical Care, 58, no. 9 (September 2020): 757-762. ↩︎
17. T. Winkelman and V. Chang, “Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions,” J Gen Intern Med, 33, no. 3 (November 2017): 376-383. ↩︎
18. Maternal Mental Health Leadership Alliance, “Fact Sheet: Maternal Mental Health Overview” (Arlington, VA: Maternal Mental Health Leadership Alliance, November 2023), available here. ↩︎
19. E. Fawcett et al., “The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis,” J Clin Psychiatry, 80, no. 4 (July 2019): 18r12527. ↩︎
20. C. Brown et al., “Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent and Cost $102 Million Yearly in the United States,” Health Affairs, 40, no. 10 (October 2021). ↩︎
21. M. Bellerose, L. Collin, & J. Daw, “The ACA Medicaid Expansion and Perinatal Insurance, Health Care Use, and Health Outcomes: A Systematic Review,” Health Affairs, 41, no. 1 (January 2022). ↩︎
22. A. Rogers et al., “Association Between Maternal Perinatal Depression and Anxiety and Child and Adolescent Development: A Meta-analysis,” JAMA Pediatr, 174, no. 11 (September 2020): 1082-1092. ↩︎
23. KFF, “Medicaid Postpartum Coverage Extensions Tracker” (Washington: KFF, January 17, 2025), available here. ↩︎
24. Georgetown Center for Children and Families, “EPSDT: A Primer on Medicaid’s Pediatric Benefit” (Washington: Georgetown Center for Children and Families, March 2017), available here. ↩︎
25. Healthy Schools Campaign: Healthy Students, Promising Futures, “School Medicaid Expansion Map,” (Chicago, IL: Healthy Schools Campaign, n.d.), available here. ↩︎
26. S. Smith et al., “Medicaid Policies to Help Young Children Access Infant-Early Childhood Mental Health Services: Results from a 50-State Survey” (Washington: Georgetown Center for Children and Families, June 9, 2023), available here. ↩︎
27. SAMHSA, “2023 NSDUH Detailed Tables.” (Rockville, MD: SAMHSA, Jule 30, 2024), available here. ↩︎
28. National Council for Mental Wellbeing, “What is a CCBHC?” (Washington: National Council for Mental Wellbeing, n.d.), available here. ↩︎
29. A. Dwyer, “HHS Selects 10 States to Participate in Medicaid Behavioral Health CLinic Demonstration” (Washington: Georgetown Center for Children and Families, June 4, 2024), available here. ↩︎
30. National Council for Mental Wellbeing, “2024 CCBHC Impact Report,” (Washington: National Council for Mental Wellbeing, n.d.), available here. ↩︎